AB0508 RISK FACTORS FOR DEVELOPMENT OF ATHEROSCLEROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: T. Panafidina, T. Popkova, L. Kondrateva, Y. Gorbunova, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) has been strongly linked to accelerated atherosclerosis and increased cardiovascular morbidity and mortality. Objectives The goal is to evaluate the traditional cardiovascular risk factors (TRF), intima-media wall thickness (IMT) and cardiovascular events (CVE) in SLE patients as compared to the same-nationality populations. Methods This cross-sectional study included 227pts (69% females, aged 35,6±0,7years) with SLE according to SLICC/ACR 2012 criteria, attending a routine visit at our Clinic between February 2018 and February 2020. Carotid plaques were assessed by ultrasound (US). Disease duration was 132,9±7,7months, SLEDAI 2K–9,4±0,5, SLICC/DI–1,89±0,13 score. Briefly, 90% had a history of joint involvement, 72%-hematological involvement, 70%-nephritis, 67%-serositis, 64%-skin lesions, 48%-neuropsychiatric involvement. Out of them 82%pts were on prednisone therapy at 17,3±1,0mg/day, 41%–on HCQ, 22%-immunosuppressants. Forty-one (18%) patients were diagnosed with SLE for the first time and were not receiving therapy at the time of enrollment. Concomitant antiphospholipid syndrome (APS) had 24% of SLEpts: 80% of SLE+APSpts had venous thrombosis, 43%-arterial, 56%-obstetric pathology. The control group (healthy donors) was matched by age and gender (n=99, 79% females, aged 36,2±0,8years). Results Patients with SLE compared to controls had a higher incidence of hypertension (52% and 21%,p&lt;0,001), triglyceride concentrations (1,60±0,07 and 0,89±0,09mmol/l,p&lt;0,001), lower levels of high-density lipoprotein (HDL) cholesterol (1,20±0,03 and 1,40±0,04mmol/l,p&lt;0,01) and a higher number of TRF (2,40±0,08 and 2,01±0,13,p&lt;0,05). Following carotid US assessment, atherosclerotic plaques (IMT≥1,5 mm) occurred in 24% of SLEpts versus 5% of controls,p&lt;0,001. SLEpts had hazard ratio (HR) of carotid plaques of 5,22 (95%CI 1,95-13,99). Clinical manifestations of atherosclerosis (CVE) were reported in 19% of SLEpts vs 2% of controls, p&lt;0,001. Out of them coronary artery disease (CAD) was in 13% vs 2%, p=0,002, myocardial infarction (MI)-in 5% vs 1%, p&gt;0,05, stroke – 7% vs 1%, p&gt;0,05. SLEpts had HR of CVE of 9,16 (95%CI 2,26-37,09), of CAD - 6,54 (95%CI 1,59-26,84). In SLEpts carotid plaques were more common than in controls at the age of 30-49 years, p&lt;0,05; clinical manifestations of atherosclerosis occurred after 40 years: CAD - at 40-49 years, stroke - &gt;50 years, p&lt;0,05. No differences were found in other age groups. Patients were found to correlate CVE with age (r=0,384,p&lt;0,001), male gender (r=0,361,p&lt;0,001), hypertension (r=0,227,p&lt;0,001), body mass index (BMI) (r=0,180,p=0,007), number of TRF (r=0,247,p&lt;0,001), SLE duration (r=0,317,p=0,001), SLICC/DI (r=0,273,p&lt;0,001), steroid use duration (r=0,255,p&lt;0,001) and cumulative prednisolone dose (r=0,163,p&lt;0,05). Conclusion The frequency of CVE (CAD, MI) and carotid plaques is higher in patients with SLE than in controls. In patients, CAD and carotid plaques were detected more frequently at the age of 30-49 years than in controls. Hypertension, hypertriglyceridemia and low HDL are the most common TRF in young SLE patients. In SLE, not only TRF and their number are associated with CVE, but also SLE duration, SLICC/DI, steroid use duration and cumulative dose. Disclosure of Interests None declared